Lakshmanadoss Umashankar, Sherazi Saadia, Aggarwal Ashim, Hsi David, Aktas Mehmet K, Daubert James P, Shah Abrar H
Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Department of Internal Medicine, Unity Health System, Rochester, NY, USA.
Cardiol Res. 2011 Feb;2(1):1-6. doi: 10.4021/cr13w. Epub 2011 Jan 20.
The aim of this study was to evaluate the overall use of implantable cardioverter defibrillators (ICD) for primary prevention of sudden cardiac arrest (SCA), among eligible patients from an outpatient cardiology clinic and to determine what factors might contribute to underutilization of ICDs.
This report was a retrospective chart review of patients with ischemic or non-ischemic cardiomyopathy and left ventricular ejection fraction ≤ 35% from an outpatient cardiology practice from January 2005 to May 2008. These patients met the eligibility criteria for ICD implantation for primary prevention of SCA. A detailed review of medical records captured distribution of ICD implantation including future plans for ICD implant, patient preference against ICD use, presence of severe co-morbidities, and any other documented reasons/contraindications regarding ICD implantation.
Of the 275 patients who were eligible for ICD for primary prevention of SCA, 119 (43%) had an ICD implantation. ICDs were used in 84 (48%) eligible men and 35 (35%) eligible women (P 0.02). Among 156 (57%) patients who did not receive ICD, 79 (28%) had severe co-morbidities precluding them from having ICD. Twenty-six patients (10%) refused to have ICD implanted. The remaining 51 (19%) patient charts did not include any documentation regarding ICD use (future plan or contraindication).
ICDs are underutilized for primary prevention of SCA, with rates of use being lowest among eligible women. This underutilization exists even after accounting for patient preferences and presence of severe co-morbid conditions that might make an otherwise eligible patient not a suitable candidate for ICD implantation.
本研究的目的是评估在一家门诊心脏病诊所符合条件的患者中，植入式心脏复律除颤器（ICD）用于心脏骤停（SCA）一级预防的总体使用情况，并确定哪些因素可能导致ICD使用不足。
本报告是对2005年1月至2008年5月在一家门诊心脏病诊所患有缺血性或非缺血性心肌病且左心室射血分数≤35%的患者进行的回顾性病历审查。这些患者符合ICD植入用于SCA一级预防的资格标准。对病历进行详细审查，记录ICD植入的分布情况，包括ICD植入的未来计划、患者对使用ICD的偏好、严重合并症的存在以及任何其他关于ICD植入的记录原因/禁忌症。
在275名符合ICD用于SCA一级预防条件的患者中，119名（43%）植入了ICD。84名（48%）符合条件的男性和35名（35%）符合条件的女性使用了ICD（P<0.02）。在156名（57%）未接受ICD的患者中，79名（28%）有严重合并症，使其无法植入ICD。26名患者（10%）拒绝植入ICD。其余51名（19%）患者的病历中没有关于ICD使用（未来计划或禁忌症）的任何记录。
ICD在SCA一级预防中的使用不足，在符合条件的女性中使用率最低。即使考虑了患者偏好以及可能使原本符合条件的患者不适合植入ICD的严重合并症情况，这种使用不足仍然存在。
